A concurrent surgical miniaudit procedure: use of generic outcome screening criteria to detect anesthesia and other perioperative problems

Findings of a study conducted at Cottonwood Hospital, in Murray, Utah, indicated that operating room personnel wee not completing incident reports for all adverse events occurring in the operating suite. With the assistance of members of the anesthesia department, a concurrent surgical miniaudit procedure was developed based on 14 generic outcome screening criteria used to identify adverse perioperative events. The new procedure has markedly improved the rate of reporting surgery and anesthesia-related adverse incidents.

Chromosomes in the Cornelia de Lange syndrome

This paper summarizes previous chromosomal studies in patients with the Cornelia de Lange syndrome showing abnormal karyotypes. We report on 45 cases of the Cornelia de Lange syndrome clinically examined by one of us (B.B.) and chromosomally studied using several different methods. Two abnormal karyotypes were found: a girl with a 45,X karyotype and a boy with a (13q14q) translocation which was also found in his phenotypically normal mother and maternal grandmother. Because of recent reports of the duplication 3q syndrome and Cornelia de Lange-like phenotypes, prometaphase chromosomes were studied in 31 patients. All karyotypes were normal. As there was an excess of boys among the younger patients, special examination for the fragile site on X(q28) was carried out. This abnormality was not found. Even though no patients with the dup(3q) syndrome were found among the Cornelia de Lange patients, chromosome studies are recommended especially in connection with genetic counselling. A recurrence rate of 2-5% must still be considered for the Cornelia de Lange syndrome.

Formiminoglutamic aciduria in a slightly retarded boy with chronic obstructive lung disease

A 2-year-old boy excreted massive amounts of formiminoglutamic acid in urine. The substance was identified as authentic formiminoglutamic acid by two-dimensional thin-layer chromatography, column chromatography and enzymatic determination. After alkaline hydrolysis the substance was converted to glutamic acid. Serum amino acid concentrations were normal. The patient had normal serum and erythrocyte folate levels. The red blood cell picture was normal. The leukocytes showed slight hypersegmentation. From the age of 3 months he exhibited recurrent otitis media and severe pulmonary infections. He had a peculiar narrow-headed look and marked universal hypotonia. The mental development was slightly retarded. Glutamate formiminotransferase deficiency is postulated. The findings lend support to the theory of glutamate formiminotransferase deficiency being a rather benign disorder of metabolism.

Severe combined immunodeficiency associated with hyperimmunoglobulinaemia E, eosinophilia and impaired neutrophil chemotaxis

A boy with severe combined immunodeficiency was found to have coexistent hyperimmunoglobulinaemia E, eosinophilia and impaired neutrophil chemotaxis. Based on the literature, a deficient regulatory function of the T-cell system is proposed as the basic defect leading to the observed impairment of the cellular and humoral immunity and, probably through hyper-immunoglobulinaemia E, to defective neutrophil chemotaxis.

Tissue specificity of the epididymal androgen dependent phospholipase A

The effect of androgens on phospholipase A in the rat epididymis, liver, heart, kidney, prostate and epididymal fat pad has been investigated both in the cytosol and in a postmitochondrial particulate cell fraction. In both cell fractions, phospholipase A activity was 10-15 times higher in the cauda epididymidis than in the other organs, including the caput epididymidis, while the corpus showed an intermediate activity. In the cauda and corpus, castration reduced phospholipase A activity in both subcellular fractions to the same level as found in the other organs, and testosterone supplementation restored the enzyme activity. No evidence of a similar androgen controlled phospholipase A was found in any other tissue examined, including the prostate.

Elevation of C-peptide immunoreactivity in plasma of normal subjects after trypsin action

After measuring the effects of trypsin on the plasma of forty-five fasting healthy subjects, a very large increase in C-peptide immunoreactivity was observed. Determination of the proinsulin concentration by gel filtration showed that this increase could not be solely imputed to conversion of circulating proinsulin into desalanyl-insulin and C-peptide by trypsin. Consequently, it is suggested that certain plasma proteins structurally similar to C-peptide might be released by the action of trypsin and crossreact in the radioimmunoassay.

High molecular weight substances with insulin immunoreactivity

Substances which react with anti-insulin antibodies, but have a higher molecular weight than insulin are described. They have been studied by various authors in pancreatic adenomas, pancreas extracts, serum and cell-free systems. Proinsulin was the first of these products to be discovered, followed by its precursor, pre-proinsulin, and subsequently by a whole series of substances of ill-defined composition and more or less similar properties, grouped under the heading of "high molecular weight immunoreactive insulin" (HWIRI).

[Extrathoracic mesothelioma by inhalation of asbestos dust (author's transl)]

Report on 22 cases of malign peritoneal mesothelioma, their occupational, epidemiological, differentialdiagnostic, and oncologic aspects being discussed. For expert opinion the special criteria for acknowledging a peritoneal mesothelioma as an occupational disease are formulated (time and level to asbestos exposition, presence of pulmonary asbestosis and/or asbestos needles, latency time of about 20 years, and malignancy of the very often diffuse peritoneal mesothelioma).

Inpatient audit simplified

One hospital's audit program identifies the necessary procedures for selecting criteria, performing audits, and conducting follow-up and shows how they can be accomplished most effectively and efficiently. In addition, it shows that a useful emergency department/outpatient audit can be conducted using data from telephone follow-up for the patients.

[Oxygen consumption of the spontaneous and artificially induced skincycle at different times of day (author's transl)]

In the "clean" rat skin purified from the panniculus carnosus the oxygen consumption of the spontaneous and artificially induced skincycle was measured at different times of day. The level of oxygen consumption correlated to diurnal and nocturnal periods. During the skincycle the oxygen consumption showed fluctuations. There were indications that the value of oxygen consumption of the early anagen is influenced by that phase of the cycle at which the new cycle is artificially induced. Furthermore, it was found that a certain decrease of oxygen consumption stimulates the quiescent hair follicles to spontaneous proliferation. During the katagen the peak value of the oxygen consumption seemed to be correlated with specially morphofunctional perifollicular changes. The application of these findings to the pathophysiology of human hair growth disturbances is discussed.

Cystic fibrosis: cell culture classes in a Danish population

The cystic fibrosis (CF) culture phenotype of dermal fibroblasts (metachromasia, metabolic cooperation) of a group of 131 Danish CF patients and their families were studied to determine the distribution of the two CF culture classes and their prognostic significance. Of these, 62.6% (82) were Class I, 31.3% (41) Class II and 61.1% (8) were proposed to be genetic compounds. The occurrence of Class II was twice that found in a group of patients from New York (13%) and Minnesota (18%). The prognosis for Class II CF patients was considered to be poorer as: (1) The initial diagnosis was made earlier in Class II than in Class I or the compounds (63% of Class II were diagnosed in the first year of life, as compared to 35% in Class I and 13% of the compounds). (2) Only 5% of the Class II patients survived over the age of 15 years, both being deceased at the end of the study in 1976, whereas 24% of Class I and 63% of the compounds were over 15 years at the end of the study. This research added further evidence for genetic heterogeneity within the clinical syndrome, cystic fibrosis.

Properties and subcellular distribution of acyl-CoA: cholesterol acyltransferase (ACAT) in guinea-pig liver

The optimal in vivo conditions for measuring liver acyl-CoA:cholesterol acyltransferase, EC.2.2.1.26 (ACAT) activity in cytoplasmic extract from guinea-pigs have been examined. ACAT in liver from ordinarily fed guinea-pigs is very low. The effect of different compounds on ACAT activity was evaluated. Sodium fluoride, oligomycin, divalent cations, oleyl-CoA, and bile acids were all shown to inhibit ACAT activity markedly. Albumin stimulated the cholesterol esterification independently of the presence of fatty acids. Subcellular distribution of liver ACAT in relation to different marker enzymes shows that the bulk of ACAT activity is present in the microsomal fraction. By comparing the esterification of exogenous and endogenous cholesterol, the results indicate that these two substrates are not esterified to the same extent. Both the 'enzyme" level and substrate quality are of importance for the high ACAT activity found in rat-liver homogenates compared to guinea-pig.

Pseudomonas aeruginosa infection in cystic fibrosis. Diagnostic and prognostic significance of Pseudomonas aeruginosa precipitins determined by means of crossed immunoelectrophoresis

A total of 133 patients with cystic fibrosis have been followed for up to 5 years with monthly examinations including bacteriological examinations of sputum. Sera from the patients were examined by means of crossed immunoelectrophoresis for the occurence and number of precipitating antibody specificites against Pseudomonas aeruginosa. Poor prognosis in cystic fibrosis was associated with chronic colonization (9 months - more than 5 years) of the respiratory tract with mucoid Pseudomonas aeruginosa, and with an onset of the chronic colonization before puberty. Among the patients with chronic Pseudomonas aeruginosa colonization, poor prognosis was associated with high numbers of precipitins against antigens from these bacteria (up to 61). The number of Pseudomonas aeruginosa precipitins increased on an average with five per year in chronically colonized patients. Rapidly increasing number of precipitins was associated with poor prognosis. Patients with any degree of impairment of the ventilatory function and any changes on the chest radiographs could contract chronic Pseudomonas aeruginosa colonization. Poor ventilatory function and severe changes on the chest radiographs was associated with high numbers of Pseudomonas aeruginosa precipitins and with poor prognosis. Although many O groups of Pseudomonas aeruginosa were found in the chronically colonized group of patients, 53% of the patients harboured strains belonging to O group 3 or 3/9, and the highest numbers of precipitins were found in serum from these patients.

Epidemiology of Cornelia de Lange's syndrome

A prevalence investigation of Cornelia de Lange's syndrome in Denmark is presented. The patients were traced by screening all institutional mentally retarded patients, patients in schools and kindergartens for imbecile patients and finally by getting information on Cornelia de Lange patients known to pediatric departments. In this way 24 patients, 10 men and 14 women, were found. This amounts to a population prevalence of 0.5/100 000. Clinical data, histories of the patients and genealogical data are presented by means of tables. The eldest patient was 49 years old, but 75% of the patients were younger than 20 years. Two of the probands were sibs. Another 2 sibs were registered as mentally retarded without specific syndromes. One case of consanguinity among parents was found. The mode of ascertainment is discussed and it is concluded that the present investigation presents a minimum prevalence figure. Four patients are presented who for various reasons were not available during the prevalence investigation proper. A prevalence figure of 0.6/100 000 is found if these 4 patients are included in the calculations. One of the last mentioned patients represented a familial case. The patient in question was a girl with a younger half-brother, the mother in common, both children being very typical cases of Cornella de Lange's syndrome.

[Silicosis and scleroderma--attempt at synopsis]

Progressive systemic sclerosis obviously more frequently appears in men working under silica dust exposure than in professionally not selected groups. Moreover, silicosis and sclerosis frequently occur combined. Pathogenetic association with regard to immunologic patterns may give an explanation for this phenomenon. Sclerosis occuring in the course of silicosis ought to be included when impairment for compensation purposes is taken into consideration.